Nosocomial infection: main cause in development of septic complications in surgical postoperative patients

Introduction

In this first attempt to prove the main cause of septic complications in postoperative ICU patients in Bulgaria's biggest hospital (more than 1000 beds) we analyzed all patient admitted in general ICU during 5 year period (1993-1997).

Methods

We provided a standard bacterial monitoring of all body media (tracheal tubes, urinary tract, blood, central venous lines, sputum and surgical wounds). According to bacterial growth we divided patients into three groups. The Group 1 included patiens without any bacterial growth. Group 2 included patients with nosocomial infection. Group 3 included patients with secondary surgical endogenous infections.

Results

Of all patients during these 5 years, we include those 913 (62.9%) who stayed for more than 72 h in ICU. Group 1 included 256 patients(28%). From Group 2 we obtained following positive cultures: 457 from tracheal tubes (88.8%), 376 from urinary tract (41.9%), 282 from blood (47.2%), 164 from central venous lines (15%) and 66 from sputum (8.8%). The dominating parhogen in cultures were: from tracheal tubes: Acinetobacter spp. (27.4%); from blood: Acinetobacter spp. (21%), Serratia spp. (16.4%), S. epidermis (21%); from urine: till 5 day E. coli (18%). Acinetobactor spp. and Citrobacter spp. (13.8%); and after 5 days: Candida spp. (25%) and Pseudomonas aeruginosia and S. aureus. In Group 3 we obtained samples from surgical wounds and drainage tubes.The dominating pathogens were the same as in other body media (Acinetobacter spp., Serratia spp.).

Conclusion

The nosocomial infection remains the main cause of septic complications in postoperative ICU patients and its emergence in ICU further rises. There is also increase in secondary endogenous surgical infection. We noted P. aeruginosa moved to third-second place as a cause of nosocomial infection. The importance of Gram-positive flora nearly equalised that of Gram-negative in ICU.